Primary malignant brain tumors present significant challenges due to their unfavorable prognosis, high recurrence rates, and resistance to treatment. Regular follow-up using magnetic resonance imaging (MRI) is crucial for guiding the multidisciplinary team (MDT) management decisions, including surgery, radiation therapy, or alternative approaches. However, interpreting post-treatment MRI scans in gliomas can be quite demanding, for example, in identifying treatment-related changes (pseudoprogression) or medication-induced effects that may not accurately reflect tumor response (pseudoresponse). Additionally, the use of non-standardized language in MRI reports can hinder effective communication between radiologists and referring physicians. While the Macdonald criteria and Response Assessment in Neuro-Oncology (RANO) guidelines have emerged as significant tools for evaluating brain tumor treatment response in clinical trials, their practical application in routine clinical settings presents challenges, including the complexity of the systems, potential variability in interpretation among radiologists, the need for multiple measurements, and a sometimes incomplete understanding of the criteria among healthcare providers. In 2018, a collaborative effort between neuroradiologists, neurosurgeons, neuro-oncologists, and radiation oncologists at Emory University led to the development of a novel system, BT-RADS, specifically intended for reporting and classifying brain tumors on contrast-enhanced MRI after treatment.